Eight hours may be the optimal time interval for bed rest in the supine position for patients with hematologic cancers, including acute leukemia, who receive intrathecal chemotherapy, according to a study published in Supportive Care in Cancer

Lumbar puncture (LP) plus intrathecal chemotherapy has greatly improved treatment efficacy in acute leukemia by preventing central nervous system (CNS) involvement. LP is a highly invasive procedure and has been associated with both serious and minor adverse events (AEs). The most commonly accepted duration for prophylactic bedrest post-LP is 6 hours, but there is a paucity of research-based data determining an optimal duration of bedrest. 

For this open-label study, researchers randomly assigned 390 patients with hematologic cancers to 6, 8, or 10 hours of bedrest in the supine position after receiving intrathecal chemotherapy. Patients received follow-up after 7 days to evaluate any complications that arose after LP, including post-lumbar puncture headache (PLPH), back pain, nausea/vomiting, and brain herniation. Researchers also assessed patients’ tolerance to stay in bed for a prolonged period. 

Of study participants, 120, 120, and 119 patients in the 6-hour, 8-hour, and 10-hour groups, respectively, completed follow-up, and were evaluable for analysis. 

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Results showed that patients assigned to 6 hours of bedrest had a significantly higher incidence of complications with 41.7% (50) vs 24.2% (29) among patients in the 8-hour group (­P=.004). Patients assigned to the 10-hour group also had a significantly lower rate of AEs (26.1%; 31) compared with patients in 6-hour group (P=.011). 

There was no significant difference between the incidence of complications among patients in the 8-hour group and 10-hour group (P=.737) 

The overall rate of complications after intrathecal chemotherapy was 30.6%. The most frequently observed complications included PLPH (15.9%), back pain (15.0%), nausea/vomiting (7.5%), and lower extremity discomfort (6.1%). 

Further analysis showed that while an additional 2 hours did not significantly affect patients’ tolerance to bedrest in the 8-hour group, 4 hours significantly decreased patients’ tolerance to bedrest in the 10-hour group. 

As 8 hours of bedrest significantly reduced the rate of complications but did not decrease patients’ tolerance to bedrest, the authors concluded that 8 hours is the optimal duration. However, “some studies showed that the incidence of complications may be reduced by a smaller needle. The optimal time for bedrest may be shortened using the smaller needle compared with the 22-G needle size. Further research is needed,” they wrote.

Reference

Li J, Li X, Tong X, et al. Investigation of the optimal duration of bed rest in the supine position to reduce complications after lumbar puncture combined with intrathecal chemotherapy: a multicenter prospective randomized controlled trialSupport Care Cancer. 2018;26(9):2995-3002.